Critical Care Endocrinology – Part I
In this multinational interview, our Education Editor Sanjay Kalra takes the help of experts from different countries around the world to explore the topic of critical care endocrinology.
What are the commonly encountered critical illnesses in your endocrine practice?
Anthonia Ogbera, Nigeria
The commonly encountered endocrine illnesses in Nigeria are diabetic emergencies and thyroid emergencies namely diabetic ketoacidosis and thyroid storm respectively. Expectedly the incidence of DKA is higher than that of thyroid storm. Although data show a decline in the occurrence of DKA, this acute complication of DM remains the leading cause of DM related admissions and deaths in Nigeria. Improved accessibility to testing and thus early detection of DM, improved competencies amongst health care workers which also translate into improved public awareness are possible contributory factors to the documented trends in DKA.
Thyroid disorders are the second commonly documented endocrine disorders (2-3) in our practice. Anecdotal evidence shows that the common risk factors for thyroid storm include late presentation, poor drug adherence and selfrecourse to alternative and complementary medicine in persons in whom the diagnosis had earlier been made.
What changes will covid-19 bring about in critical care endocrinology in your country?
Hugo L. Fideleff, Argentina
On March 11th the WHO declared infection by the corona SARS-Cov-2 causing COVID-19 disease a global pandemic. Argentina implemented national crisis management plans and routine care and elective procedures have been postponed. Endocrine societies in Argentina have shared recommendations for the safe management of endocrine patients as regards limited resources and national practice characteristics. These recommendations include treatment of thyroid diseases, pituitary tumors, Cushing disease and some pediatric endocrine pathologies as growth, precocious puberty and adrenal insufficiency.
Finally, it seems plausible that the experience with remote and virtual follow-up of some patients will be another tool to be taken into account once the acute effect of the pandemic is over.
Which pituitary diseases do you encounter in a critical care setting? What can we do to prevent them?
Bashir Ahmad Laway, India
Admissions to critical care services due to pituitary diseases are quite common in this part of the country. Though pituitary apoplexy in previously undiagnosed pituitary tumors remains common in our ER, myriad presentations of a hypopituitarism including Sheehan syndrome are frequently encountered as well. The plethoric presentations of hypopituitarism including but not limited to electrolyte imbalance mainly hyponatremia, refractory hypoglycemia, ventricular arrhythmias, profound shock, encephalopathy, seizures, coma and even psychosis has been frequently reported from our center in the past.
While preventing these pituitary diseases per se, is often not possible except for Sheehan syndrome which is amenable for complete prevention with better obstetric services, I feel we can significantly reduce the morbidity and mortality by a two-tier approach going forward. A physician-centric approach for prompt recognition of these conditions during primary admission will result in the early institution of treatment and reduce mortality to a great extent. A patient-centric approach by educating them regarding the level of self-care the disease demands can prevent frequent re-admissions with crisis. Establishing and enrolling these patients in disease-specific support groups will go a long way in addressing this issue.